Based on PubMed | Can lupus cause heart palpitations, and when should a person with lupus be concerned about them?

Lupus and Heart Palpitations: What to Know and When to Act

Yes systemic lupus erythematosus (lupus) can be linked to heart palpitations. This can happen because lupus causes inflammation that may involve the heart’s lining (pericarditis), the heart muscle (myocarditis), the heart valves, the blood vessels, or the heart’s electrical system, any of which can lead to sensations of a fast, fluttering, or irregular heartbeat. ^[1] In addition, people with lupus have a higher long‑term risk of coronary artery disease, which can also cause palpitations and other heart symptoms. ^[1]

How Lupus Can Lead to Palpitations

• Inflammation of the heart muscle (myocarditis) can irritate heart cells and trigger abnormal rhythms or conduction problems. ^[2] Myocarditis in lupus may progress to arrhythmias, conduction disturbances, or even heart block if not treated promptly. ^[3]
• Pericarditis (inflammation of the sac around the heart) is one of the most common heart issues in lupus and can cause chest discomfort and sometimes palpitations. ^[4] Pericardial effusions (fluid around the heart) are also more frequent in lupus and may be silent or cause symptoms. ^[5]
• Valve abnormalities (such as Libman–Sacks endocarditis) and scarring can alter blood flow and indirectly provoke palpitations. ^[5]
• Direct involvement of the heart’s conduction system can cause first‑degree AV block or even complete heart block, leading to irregular or skipped beats. ^[5]
• Accelerated atherosclerosis in lupus raises the chance of coronary problems over time, which may present with palpitations, chest pain, or shortness of breath. ^[6]

How Common Are Heart Rhythm Problems in Lupus?

Cardiac involvement is relatively common in lupus and can affect the pericardium, myocardium, coronary arteries, valves, and the conduction system. ^[2] In multi‑ethnic inception cohorts, about 14% of people developed a “primary cardiac” manifestation within the first years of disease, with pericarditis being most frequent and arrhythmias occurring in a smaller subset. ^[7] While many rhythm changes are mild, lupus‑related myocarditis or conduction disease can be clinically significant and requires prompt assessment. ^[2]

When a Person with Lupus Should Be Concerned

Some palpitations are harmless, but certain features suggest urgent evaluation is needed. Seek emergency care now if palpitations occur with any of the following:

• Chest pain, trouble breathing, fainting, severe dizziness, unusual sweating, or feeling very unwell. ^[8] You should also seek urgent help if your pulse is very fast or clearly irregular, or if you pass out. ^[9]

Contact your clinician promptly (same day or within 24–48 hours) if:

• Palpitations are frequent (e.g., clusters of extra beats or repeated episodes), new, worsening, or associated with known heart disease or risk factors. ^[8]
• You have lupus symptoms suggesting a flare such as chest pain from breathing (pleurisy), new swelling, fever, or fatigue because these can accompany pericarditis or myocarditis. ^[1]
• You notice new exertional shortness of breath, reduced exercise tolerance, or leg swelling, which may indicate heart involvement. ^[2]

What Evaluation May Include

• History and exam focused on triggers, medications (including steroids or stimulants), and lupus activity. ^[2]
• Electrocardiogram (ECG) to look for rhythm disturbances or conduction blocks. ^[5]
• Blood tests (e.g., markers of inflammation or heart injury) and echocardiography to assess heart structure, valve function, and pericardial fluid. ^[4]
• Advanced imaging (cardiac MRI) if myocarditis is suspected; in select cases, endomyocardial biopsy can confirm inflammation. ^[3]
• Cardiologist involvement is often appropriate when heart or vascular damage is suspected, coordinated with the lupus care team. ^[10]

Treatment Approaches

Treatment is tailored to the cause:

• Lupus‑related myocarditis or pericarditis is generally treated with anti‑inflammatory and immunosuppressive therapies to control the underlying inflammation, often alongside standard cardiac care. ^[4] Myocarditis merits urgent attention to prevent progression to serious arrhythmias or heart failure. ^[3]
• Rhythm control may include medications or, in selected cases, procedures guided by a cardiologist. ^[2]
• Managing traditional cardiovascular risks (blood pressure, cholesterol, smoking, diabetes) is important because lupus independently raises cardiovascular risk beyond standard factors. ^[6]
• Ongoing lupus therapy, including antimalarials, may be protective against some cardiac manifestations. ^[7]

Red Flags and Action Steps

Situation	What to Do
Palpitations with chest pain, shortness of breath, fainting, severe dizziness, or heavy sweating	Call emergency services immediately. [8] [9]
New or worsening frequent palpitations, known heart disease, or significant risk factors	Contact your clinician promptly for evaluation. [8]
Known or suspected lupus flare with chest symptoms	Arrange same‑day assessment; consider cardiology input. [10] [4]

Long‑Term Heart Health in Lupus

People with lupus face a higher lifetime risk of heart disease, especially younger women compared with peers, so preventive cardiology is considered a key part of care. ^[6] Controlling lupus activity, using heart‑healthy habits, and regular check‑ups can help lower the risk of serious complications. ^[6]

Key Takeaways

• Lupus can cause palpitations through inflammation of the heart’s lining or muscle, valve problems, and conduction abnormalities. ^[2] Pericarditis is common, and myocarditis though less common can be serious and requires prompt care. ^{[4] [3]}
• Seek urgent care for palpitations with alarming symptoms such as chest pain, shortness of breath, fainting, marked dizziness, or a very fast/irregular pulse. ^{[8] [9]}
• Work with your lupus team and a cardiologist when heart involvement is suspected to identify the cause and tailor treatment. ^[10]